Selective Amygdalohippocampectomy for Temporal Lobe Epilepsy Management

Epilepsy surgery has a proven treatment effect on patients with medical intractable partial seizures, presumably through its resection of epileptogenic zone. This prospective and nonrandomized controlled study examines whether minimal invasive microneurosurgical interventional through frontolateral trans-sylvian approach for a high selective amygdalohippocampectomy would reduce the frequency of epilepsy and antiepileptic drugs (AEDS), for patients who have had long history of poor response on pharmacotherapy, via measuring over one year the clinical, activity of daily living and EEG outcomes. Our inclusion/ exclusion criteria for selected cases and according to the definition of ILAE are, intractable temporal lobe epilepsy (TLE) either right or left side origin, all patients had a history of treatment for more than 13 years by AEDS polytherapy and according to our inclusion criteria they should have at least 4 seizures a month. Selective amygdalohippocampectomy was done for 17 patients and all of them were followed up for one year. The study confirmed that selective amygdalohippocampectomy reduces the seizures frequency and drugs doses in patients with mesial temporal lobe epilepsy (MTS). However, amygdalohippocampectomy did not signify cessation of all AEDS, but all patients showed satisfactory seizure free outcome under monotherapy. There is also significant difference in epilepsy frequency postoperatively especially psychomotor component. The findings are important for the understanding of selective amygdalohippocampectomy role in the treatment of intractable TLE (MTS) with or without secondary generalization. (Egypt J. Neurol. Psychiat. Neurosurg., 2007, 44(2): 615-622)